Abstract Introduction: The use of statins in hemodialysis patients is a topic of ongoing research and debate. Patients with chronic kidney disease on hemodialysis constitute a large proportion of patients treated in the vascular surgery field. Clinical data of the protective statin effect on this group is scarce and conflicting results exist regarding cardiovascular, cerebrovascular and limb outcomes. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases to understand the relationship between statin effect and cardiovascular, limb outcomes and cerebrovascular outcomes. A narrative review was constructed, based on the obtained literature. Results: Although the use of statins in hemodialysis patients may provide cardiovascular benefits, the optimal dosage and safety profile of these medications in this population remain uncertain. A carefully evaluation of the risks and benefits of statins should be made based on each patient's specific requirements and circumstances. Conclusion: The role of statins for patients with peripheral arterial disease who are on hemodialysis remains unclear. Further analyses should focus on this subgroup of dialysis patients, who are becoming more prevalent on the vascular surgery departments, allowing for an optimized treatment with better patient outcomes.

Abstract Introduction: The descending thoracic aorta (DTA) has been used as inflow mostly as a secondary option for revascularization after either graft failure/infection or other intra-abdominal pathologies contraindicating a standard abdominal aortic approach. The objective of this review is to summarize current evidence on the use of this inflow site for revascularization procedures. Methods: A comprehensive electronic literature search was performed, using PubMed and Embase databases. All literature published in English in the last 30 years was considered. The main goal was to assess the feasibility and practicality of implementing this approach in cases of severe and complex aortoiliac lesions. Results: Our review comprised 11 articles. DTA has been used predominately as a secondary option. The 30-day mortality rate was 4% (9/222). Secondary graft patency at 5-years was generally high across all studies. The use of DTA as inflow has been shown to be a safe and effective option for aorto-iliac reconstruction. Conclusion: DTA can be used safely as an inflow for lower-limb revascularization and it remains an important tool in the vascular surgeon's armamentarium.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). Results: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. Conclusions: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). Results: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. Conclusions: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Resumo: O objetivo deste estudo foi avaliar a associação das condições de nascimento, do estado nutricional e do crescimento infantil com fatores de risco cardiometabólicos aos 30 anos de idade. Também foi verificado se o índice de massa corporal (IMC) aos 30 anos mediava a associação entre o ganho de peso na infância e fatores de risco cardiometabólicos. Trata-se de um estudo de coorte prospectivo que incluiu todos os nascidos vivos em 1982 em hospitais da cidade de Pelotas, Rio Grande do Sul, Brasil, residentes da área urbana. As mães foram entrevistadas no parto e os participantes foram acompanhados em diferentes idades. Para as análises, foram utilizados os dados de peso e altura coletados no nascimento e aos 2 e 4 anos de idade e fatores de risco cardiovascular aos 30 anos. Regressões lineares múltiplas foram realizadas para a obtenção de coeficientes ajustados e G-fórmula para a análise de mediação. O ganho de peso relativo na infância, apesar da idade, está positivamente associado à pressão arterial média, enquanto o ganho de peso relativo tardio na infância está positivamente associado à espessura médio-intimal da artéria carótida, à velocidade da onda de pulso, aos triglicerídeos, ao colesterol não-HDL, à glicose plasmática e à proteína C reativa. O IMC na idade adulta capturou o efeito total do ganho de peso relativo entre 2 e 4 anos sobre a espessura médio-intimal da carótida, os triglicerídeos, o colesterol não-HDL e a proteína C reativa. Estes achados reforçam a evidência de que o rápido ganho de peso relativo após os 2 anos de idade pode ter consequências a longo prazo sobre o risco de distúrbios metabólicos e cardiovasculares.

Resumen: El objetivo de este estudio fue evaluar la asociación de las condiciones de nacimiento, estado nutricional y crecimiento infantil con factores de riesgo cardiometabólico a los 30 años de edad. También se verificó si el índice de masa corporal (IMC) a los 30 años mediaba la asociación entre el aumento de peso infantil y los factores de riesgo cardiometabólicos. Se trata de un estudio de cohorte prospectivo que incluyó todos los nacidos vivos en 1982 en hospitales de la ciudad de Pelotas, estado de Río Grande del Sur, Brasil, residentes del área urbana. Las madres fueron entrevistadas en el momento del parto y los participantes fueron seguidos a diferentes edades. Para los análisis, utilizamos los datos de peso y altura recopilados al nacer y a los 2 y 4 años de edad y los factores de riesgo cardiovascular a los 30 años. Se realizaron regresiones lineales múltiples para obtener coeficientes ajustados y la G-fórmula para el análisis de mediación. El aumento de peso relativo en la infancia, a pesar de la edad, se asocia positivamente con la presión arterial media, mientras que el aumento de peso relativo en la infancia tardía se asocia positivamente con el espesor de la íntima-media de la arteria carotídea, la velocidad de la onda del pulso, los triglicéridos, el colesterol no HDL, la glucosa plasmática y la proteína C reactiva. El IMC en adultos capturó el efecto completo del aumento de peso relativo a los 2 y 4 años sobre el espesor de la íntima-media carotídea, los triglicéridos, el colesterol no HDL y la proteína C reactiva. Estos hallazgos refuerzan la evidencia de que el rápido aumento de peso relativo después de los 2 años puede tener consecuencias a largo plazo sobre el riesgo de trastornos metabólicos y cardiovasculares.

Abstract: This study aimed to assess the association of birth conditions, nutritional status, and childhood growth with cardiometabolic risk factors at 30 years of age. We also evaluated whether body mass index (BMI) at 30 years mediated the association of weight gain in childhood with cardiometabolic risk factors. This is a prospective cohort study that included all live births in 1982 in hospitals in the city of Pelotas, Rio Grande do Sul State, Brazil, whose families lived in the urban area. Mothers were interviewed at birth, and participants were followed at different ages. For our analyses, we used data on weight and height collected at birth, 2 and 4 years and cardiovascular risk factors at 30 years. Multiple linear regressions were performed to obtain adjusted coefficients and G-formula for mediation analysis. Relative weight gain in childhood, despite the age, was positively related to mean arterial pressure, whereas relative weight gain in late childhood was positively associated with carotid intima-media thickness, pulse wave velocity, triglycerides, non-HDL cholesterol, plasma glucose, and C-reactive protein. BMI in adulthood captured the total effect of relative weight gain in the period between 2 and 4 years on carotid intima-media thickness, triglycerides, non-HDL cholesterol, and C-reactive protein. Our findings reinforce the evidence that rapid relative weight gain after 2 years of age may have long-term consequences on the risk of metabolic and cardiovascular disorders.

Abstract: This study aimed to assess the association of birth conditions, nutritional status, and childhood growth with cardiometabolic risk factors at 30 years of age. We also evaluated whether body mass index (BMI) at 30 years mediated the association of weight gain in childhood with cardiometabolic risk factors. This is a prospective cohort study that included all live births in 1982 in hospitals in the city of Pelotas, Rio Grande do Sul State, Brazil, whose families lived in the urban area. Mothers were interviewed at birth, and participants were followed at different ages. For our analyses, we used data on weight and height collected at birth, 2 and 4 years and cardiovascular risk factors at 30 years. Multiple linear regressions were performed to obtain adjusted coefficients and G-formula for mediation analysis. Relative weight gain in childhood, despite the age, was positively related to mean arterial pressure, whereas relative weight gain in late childhood was positively associated with carotid intima-media thickness, pulse wave velocity, triglycerides, non-HDL cholesterol, plasma glucose, and C-reactive protein. BMI in adulthood captured the total effect of relative weight gain in the period between 2 and 4 years on carotid intima-media thickness, triglycerides, non-HDL cholesterol, and C-reactive protein. Our findings reinforce the evidence that rapid relative weight gain after 2 years of age may have long-term consequences on the risk of metabolic and cardiovascular disorders.

Resumen: El objetivo de este estudio fue evaluar la asociación de las condiciones de nacimiento, estado nutricional y crecimiento infantil con factores de riesgo cardiometabólico a los 30 años de edad. También se verificó si el índice de masa corporal (IMC) a los 30 años mediaba la asociación entre el aumento de peso infantil y los factores de riesgo cardiometabólicos. Se trata de un estudio de cohorte prospectivo que incluyó todos los nacidos vivos en 1982 en hospitales de la ciudad de Pelotas, estado de Río Grande del Sur, Brasil, residentes del área urbana. Las madres fueron entrevistadas en el momento del parto y los participantes fueron seguidos a diferentes edades. Para los análisis, utilizamos los datos de peso y altura recopilados al nacer y a los 2 y 4 años de edad y los factores de riesgo cardiovascular a los 30 años. Se realizaron regresiones lineales múltiples para obtener coeficientes ajustados y la G-fórmula para el análisis de mediación. El aumento de peso relativo en la infancia, a pesar de la edad, se asocia positivamente con la presión arterial media, mientras que el aumento de peso relativo en la infancia tardía se asocia positivamente con el espesor de la íntima-media de la arteria carotídea, la velocidad de la onda del pulso, los triglicéridos, el colesterol no HDL, la glucosa plasmática y la proteína C reactiva. El IMC en adultos capturó el efecto completo del aumento de peso relativo a los 2 y 4 años sobre el espesor de la íntima-media carotídea, los triglicéridos, el colesterol no HDL y la proteína C reactiva. Estos hallazgos refuerzan la evidencia de que el rápido aumento de peso relativo después de los 2 años puede tener consecuencias a largo plazo sobre el riesgo de trastornos metabólicos y cardiovasculares.

Resumo: O objetivo deste estudo foi avaliar a associação das condições de nascimento, do estado nutricional e do crescimento infantil com fatores de risco cardiometabólicos aos 30 anos de idade. Também foi verificado se o índice de massa corporal (IMC) aos 30 anos mediava a associação entre o ganho de peso na infância e fatores de risco cardiometabólicos. Trata-se de um estudo de coorte prospectivo que incluiu todos os nascidos vivos em 1982 em hospitais da cidade de Pelotas, Rio Grande do Sul, Brasil, residentes da área urbana. As mães foram entrevistadas no parto e os participantes foram acompanhados em diferentes idades. Para as análises, foram utilizados os dados de peso e altura coletados no nascimento e aos 2 e 4 anos de idade e fatores de risco cardiovascular aos 30 anos. Regressões lineares múltiplas foram realizadas para a obtenção de coeficientes ajustados e G-fórmula para a análise de mediação. O ganho de peso relativo na infância, apesar da idade, está positivamente associado à pressão arterial média, enquanto o ganho de peso relativo tardio na infância está positivamente associado à espessura médio-intimal da artéria carótida, à velocidade da onda de pulso, aos triglicerídeos, ao colesterol não-HDL, à glicose plasmática e à proteína C reativa. O IMC na idade adulta capturou o efeito total do ganho de peso relativo entre 2 e 4 anos sobre a espessura médio-intimal da carótida, os triglicerídeos, o colesterol não-HDL e a proteína C reativa. Estes achados reforçam a evidência de que o rápido ganho de peso relativo após os 2 anos de idade pode ter consequências a longo prazo sobre o risco de distúrbios metabólicos e cardiovasculares.

Abstract Background: Individualized risk assessment using comorbidity adjustment is an important component in modern clinical practice and can be performed considering individual comorbidities or through the use of summary measures. The Charlson Comorbidity Index adjusted to age (CCIa) is the most widely validated and used comorbidity assessment tool. Studies have proved CCIa as a strong predictor of mortality for a variety of medical and surgical conditions; however, its utility in patients submitted to elective endovascular abdominal aortic aneurysm repair (EVAR) has not been studied. Methods: Patients submitted to EVAR between January 1, 2017 and December 31, 2021 in our tertiary, academic Vascular Surgery Department were retrospectively evaluated and 123 patients fulfilled the inclusion criteria. Patient characteristics and peri-operative variables were collected and CCIa was calculated. Surgical complications were classified according to Clavien-Dindo. The area under the curve of the receiver operating characteristic curves was calculated to validate and determine the discriminating ability of CCIa in predicting complications and mortality and the Youden index used to determine the critical value. Results: Mean age was 73.49±7.95 years and mean follow-up was 30.55±16.49 months. 30-day complication rate was 16%, 30-day mortality 1.63% and overall mortality 16%. Patients with higher CCIa had higher overall mortality (p=.002) but CCIa had no impact on 30-day complication rate and on 30-day mortality. Logistic regression showed that even after adjusting for patient´s comorbidities individually, CCIa was the only independent mortality predictor (p=.003). The optimal cutoff associated with higher overall mortality was found to be ≥6. Conclusion: CCIa does not seem to predict complications and early mortality after EVAR but it seems to be a useful predictor of mid-term survival after EVAR. These results show the limited role of this score in predicting outcomes after surgery but may help identify a sub-population whose shorter life-expectancy should be considered towards the benefits of EVAR.

Resumo Introdução: Apesar dos esforços das equipas de saúde, a taxa da amputação em doentes com Isquémia Crítica Ameaçadora de Membro (CLTI) é bastante elevada. Cada vez mais se torna relevante um tratamento individualizado do doente por forma a melhorar a sua qualidade de vida. Contudo, não existe uma escala de qualidade de vida validada para doentes amputados por isquémia crítica. Os autores propõem uma revisão sistemática da literatura com vista a sumarizar as escalas de avaliação de qualidade de vida após amputação. Métodos: Foi feita uma pesquisa por todos os estudos relacionados com avaliação funcional e da qualidade de vida após amputação na base de dados Pubmed. Resultados: Dos 245 artigos foram incluídos 29. Dos artigos analisados apenas 9 avaliaram exclusivamente doentes vasculares com CLTI. Foram identificados 27 testes/escalas diferentes: 14 escalas de avaliação de saúde ou função (física ou mental) e 13 escalas de qualidade de vida ou qualidade de saúde. Os testes de função mais utilizados na população de amputados foram os testes de marcha, validados em amputados, e escalas de atividades de vida diária, e os testes de avaliação de qualidade mais usados foram as escalas gerais World Health Organization Quality of Life Assessment Instrument-Bref (WHOQOL-BREF) e Short Form 36 - General Health Status Survey (SF-36) e a escala específica para amputados Trinity Amputation and Prosthesis Experiences Scales (TAPES). A escala específica para Doença Arterial Obstrutiva Periférica (DAOP) Vascular Quality of Life Questionnaire (VascuQoL) apenas foi utilizada uma vez. Conclusões: Na população de doentes amputados vasculares, escalas gerais podem não representar corretamente os domínios mais valorizados por esta população, geralmente mais idosos e com limitações prévias. Na ausência de uma escala específica para esta população, os índices de avaliação de atividades de vida diária ou os testes de marcha em doentes mais jovens ou protetizados juntamente com o questionário WHOQOL-BREF aparentam ser a melhor opção na avaliação da QoL. São essenciais novos estudos para validar uma escala específica para esta população.

Resumo A sífilis é uma infeção sistémica com manifestações variáveis consoante o seu estádio clínico. Conhecida como “a grande imitadora”, a sua abordagem é ainda mais desafiante quando ocorre a reação de Jarisch-Herxheimer (JH). Esta trata-se de uma reação febril aguda autolimitada que pode ocorrer nas 24 horas após tratamento de uma infeção por espiroquetas. Reporta-se o caso de um homem de 33 anos com sífilis secundária que desenvolve uma reação de JH após três horas da administração de benzilpenicilina benzatínica 2,4 milhões de unidades internacionais, apresentando febre, agravamento do exantema inicial, dor abdominal e disfunção hepatocelular, estas últimas manifestações descritas como incomuns. Os autores discutem a fisiopatologia desta reação, as suas manifestações clínicas e recomendações de abordagem à luz da evidência atual.

Abstract Syphilis is a systemic infection with variable manifestations depending on its clinical stage. Known as "the great imitator", its management is even more defying when the Jarisch-Herxheimer reaction occurs, which is a self-limited acute febrile reaction that occurs within 24 hours after treatment for a spirochete infection. The authors describe the case of a 33-year-old man with a secondary syphilis who, three hours after the administration of benzathine benzylpenicillin 2.4 million international units, presents with fever, worsening of the initial cutaneous manifestations, abdominal pain and hepatocellular dysfunction, these last two described as unusual manifestations of this reaction. The authors discuss the pathophysiology of the Jarisch-Herxheimer reaction, its clinical manifestations and management recommendations according to the current evidence.

Resumo As pesquisas em Paleogenômica têm encontrado nos acervos de Antropologia e História uma riquíssima fonte de material para análise do genoma de organismos que já não existem mais. Com objetos de museus, essa nova área científica tem conseguido interpretar as relações entre espécies extintas e atuais e dar evidências à ação antrópica em processos de extinção. Ao reforçar o paradoxo do Antropoceno – uma nova época geológica em que se destrói para prosperar –, os museus se inserem na discussão sobre correr riscos de danificar ou perder acervos museológicos em prol do desenvolvimento científico. Assim, este artigo visa contribuir com o debate sob a perspectiva museológica, analisando aspectos relacionados à responsabilidade e ao compromisso com a preservação e a pesquisa nos museus, com atenção especial à ‘aura’ do objeto. Para a construção dos argumentos, enfoca-se o caso de uma das maiores coleções de cornos adornados do mundo, do Museu Nacional da Dinamarca, útil para a interpretação do processo de extinção dos auroques. Ao final, reconhecendo os museus como aliados ao paradoxo do Antropoceno, considera-se a Museologia a área mais afetada pelo dilema e recomenda-se atenção a oito conjuntos de perguntas que surgem sempre que a questão se estabelecer em um museu.

Abstract Paleogenomics researches has found in anthropological and historical collections a very rich source of material for analyzing genome of organisms that no longer exist. With museum objects, that new scientific area has been able to interpret the relationships between extinct and current species and provide evidence of anthropic action in extinction processes. By reinforcing the Anthropocene paradox - a new geological epoch based on destruction in order to prosper - museums start a discussion about taking risks of damaging and even losing museum collections in favor of scientific development. This article aims to contribute to the debate from a museological perspective, analyzing aspects related to responsibility and commitment to preservation and research in museums, with special attention to the aura of the object. It focuses on the specific case of one of the largest collections of drinking horns in the world, from the National Museum of Denmark, useful for the interpretation of the auroch’s extinction process. Finally, museums are recognized as allies to the Anthropocene paradox, whilst Museology is considered the most affected area by the dilemma. Therefore, attention to eight sets of questions is recommended, whenever this situation becomes real in a museum.

Resumo Objetivos: Os cuidados de saúde primários (CSP) são o terreno ideal para rastreio e tratamento de doentes com Problemas Ligados ao Álcool (PLA). Este estudo pretendeu avaliar as atitudes dos participantes da Escola de Medicina Geral e Familiar (Primavera 2016) relativas a PLA e comparar as atitudes dos participantes do curso de Alcoologia com os dos restantes cursos. Métodos: Foram avaliadas as atitudes dos participantes através do Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Foram investigadas as associações entre sexo, idade e local de trabalho e ainda com os resultados do SAAPPQ. Resultados: Obtiveram-se 250 questionários elegíveis. A idade média foi de 28,1 ± 2,2 anos; 86,2% eram do sexo feminino. A Administração Regional de Saúde (ARS) mais representada foi a de Lisboa e Vale do Tejo. Pré-curso, as atitudes dos participantes dos dois grupos foram semelhantes, exceto na Adequação e Segurança. Os participantes do curso de Alcoologia sentem-se seguros ao trabalharem com estes doentes. Contudo, apenas 65% destes pontuaram acima do ponto médio no Compromisso Terapêutico. Pós-curso objetivaram-se valores significativamente superiores em todas as subescalas para os participantes do curso de Alcoologia, tendo a totalidade pontuado acima do ponto médio na Segurança e Compromisso Terapêutico. Conclusões: As atitudes dos participantes do curso de Alcoologia perante doentes com PLA melhoraram significativamente após a formação em todas as subescalas. Cursos que tenham em conta não só conhecimento e capacidade técnica, como outras atitudes, poderão melhorar o rastreio e tratamento de doentes com PLA. Poderá ser necessária uma atenção curricular específica nos domínios da Autoestima e Satisfação para melhorar resultados futuros.

Abstract Introduction: Primary health care represents the ideal setting for screening and treatment of patients with Alcohol-Related Problems. This study aims to assess the attitudes of the participants of the School of General Practice (GP) Spring 2016 concerning ARP and compare the attitudes of the participants of the Alcohology course with participants from other courses. Material and Methods: We assessed the attitudes of the participants using the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). We investigated associations between sex, age, and workplace, and with results from SAAPPQ. Results: Two hundred and fifty eligible questionnaires were obtained. The average age was 28.1 ± 2.2 years old and 86.2% were female. The most represented workplace was Lisbon and Vale do Tejo. Pre-course, GPs’ attitudes of both groups were homogeneous except on Adequacy and Role Security. The participants of the Alcohology course feel more secure in working with these patients. However, only 65% scored above midpoint in Therapeutic Commitment. Post-course, there were significantly higher values in all subscales for participants of the Alcohology course, with all scoring above midpoint in Safety and Therapeutic Commitment. Discussion: The attitudes of the participants of the Alcohology course towards patients with ARP significantly improved after training in all evaluated subscales. Conclusions: Courses that take into account not only GP’s knowledge and skills, but also other attitudes, may be important to improve screening and treatment of patients with ARP. Explicit curricular attention to Self-esteem and Satisfaction may be required to improve further results.

Resumo: O artigo investiga as representações sociais (RS) da docência entre os trabalhadores com baixa escolaridade (TBE) e vulnerabilidade social, pais de alunos de escolas públicas. Problematiza as RS dos TBE levando em consideração o histórico e as vinculações deles e de seus filhos com a escola pública. A fundamentação teórica das RS é a abordagem dimensional de Moscovici. Participaram da pesquisa 145 pessoas, entre desempregadas, em situação laboral instável ou informal. Das entrevistas foram retiradas as falas dos participantes sobre a escola e as representações sobre o trabalho docente. As informações foram analisadas com o auxílio do software Alceste e da análise de conteúdo. As produções discursivas sobre a docência indicam as RS idealistas como promotoras de um futuro melhor, as RS normativas como trabalho de correção e disciplinamento social e a RS de um trabalho relacional como atividade interpessoal, permeada pelo afeto e motivação dos alunos.

Abstract: This paper investigates social representations of teaching (RS - from representações sociais, in Portuguese) among lowly-schooled (TBE - from trabalhadores com baixa escolaridade, in Portuguese) and socially-vulnerable workers with kids in the public-school system. It problematizes the RS of TBE, considering their and their children’s history and connections with the public school. The RS have been theoretically founded on Moscovici’s dimensional approach. One-hundred-and-forty-five people, including those unemployed and working under an unstable or informal employment, took part on the research. Interviews revealed participant’s opinions on school and the representations of the teaching work. Then, the software Alceste and content analysis were used to analyze the information. Discursive productions about teaching put the idealist RS as promoters of a better future, the regulative RS as correctional and socially-disciplinary work, and the RS of a relational work as interpersonal activity, permeated by students’ affection and motivation.

Resumen: Este trabajo investiga representaciones sociales (RS) de la docencia entre trabajadores con baja escolaridad (TBE) y vulnerabilidad social, padres de alumnos de escuelas públicas. Problematiza las RS de los TBE considerando el histórico y las vinculaciones de eses trabajadores y de sus hijos con la escuela pública. La fundamentación teórica de las RS es el abordaje dimensional de Moscovici. Participaron de la investigación 145 personas, entre desempleadas, en situación laboral inestable o informal. De las entrevistas fueron retiradas las hablas de los participantes sobre la escuela y las representaciones sobre el trabajo docente. Las informaciones fueron analizadas con ayuda del software Alceste y del análisis del contenido. Las producciones discursivas sobre la docencia indican las RS idealistas como promotoras de un futuro mejor, las RS normativas como trabajo de corrección y disciplinamiento social, y la RS de un trabajo relacional como actividad de relación interpersonal, permeada por el afecto y motivación de los alumnos.

Resumen Introducción: El torniquete utilizado en la venopunción aparece como potencial vehículo para transmisión de microorganismos que entorpece la seguridad y calidad de los servicios clínicos. Objetivo: Mapear pruebas científicas sobre contaminación microbiológica de los torniquetes utilizados en la venopunción periférica. Metodología: Revisión de acuerdo con la metodología del Instituto Joanna Briggs. Resultados: Se han incluido 20 estudios, en los que se analizó un total de 1477 torniquetes. Las tasas de contaminación microbiológica variaron entre 10-100% y 19 estudios informaron la presencia de S. aureus, 11 detectaron cepas resistentes a meticilina con prevalencia entre 3.3-58.3%. Conclusión: La tasa de contaminación en mayoría de los estudios fue ≥70%, 4 estudios que habían muestreado ≥100 torniquetes. Nuestro estudio evidencia que los torniquetes son reservorios de patógenos y pueden transmitirse al paciente en manos del personal. Recomendamos estudios que confirmen que los torniquetes pueden ser responsables de las infecciones asociadas a la atención médica.

Abstract Introduction: The tourniquet used in venipuncture appears as a potential vehicle for the transmission of microorganisms that interferes with safety and the quality of clinical services. Objective: Mapping the scientific evidence on the microbiological contamination of the tourniquets used in peripheral venipuncture. Methodology: Scoping review following the Joanna Briggs Institute methodology. Results: 20 studies have been included, in which of 1477 tourniquets were analyzed. The rates of microbiological contamination varied between 10-100% and 19 studies reported the presence of S. aureus, 11 of them detected methicillin-resistant strains with prevalence between 3.3-58.3%. Conclusion: The contamination rate in the majority of studies was ≥70%, including 4 studies which had sampled ≥100 tourniquets. The evidence of our study is that the tourniquets are reservoirs of potential pathogens and can be transmitted to patient on staff hands. We recommend studies that confirm the reusable tourniquets can be responsible to healthcare associated infections.

Abstract Hypoperitectic Cu − 20 wt.% Sn alloy was solidified under different cooling rates and solidification growths using directional solidification system. The effects of cooling rate and solidification growth on the microsegregation profiles and tertiary dendritic arm spacing (λ3) were experimentally investigated along the casting. A mathematical model known as phase-field was applied to simulate microstructure and microsegregation during solidification in system Cu-Sn liquid. In this paper the applicability of the phase-field model to the solidification problem in a real alloy system was systematically explored. Microsegregation profiles and realistic dendritic structures were obtained using the phase-field model. The results calculated by phase-field model show various solidification features consistent with our experiment. The calculated tertiary dendritic arm spacing (λ3) and microsegregation profiles were compared with experimental values from directional solidification system. Since the calculated microsegregation profiles using the equilibrium partition coefficient (keq) can yielded discrepancies from the experimental results, an effective partition coefficient (kef) as a function of solidification growth, is proposed in phase-field model, showing a good agreement with the experimental data for any case examined.

RESUMO Objetivo Compreender como a articulação teórico-prática se efetiva num currículo de um curso de graduação em Enfermagem. Método Trata-se de um estudo de caso único, com abordagem qualitativa, desenvolvido por meio de análise documental e por entrevistas individuais com roteiro semiestruturado com dez docentes e 14 discentes entrevistados no período de fevereiro a maio de 2015. A análise dos dados foi realizada segundo os pressupostos da Análise Crítica do Discurso. Resultados Os dados revelaram a existência de tensões e ambivalências entre duas formas de relação entre teoria e prática. A primeira, relacionada à teoria-prática como unidade indissolúvel e a segunda à visão da teoria e prática como instâncias dicotômicas e predomínio da teoria precedendo a prática. Conclusões e implicações para a prática Há fragilidades na efetivação da articulação teórico-prática no currículo do curso de Enfermagem investigado, evidenciando a supremacia do paradigma cartesiano no ensino superior de Enfermagem. Dessa forma, torna-se premente instituir estratégias que viabilizem a indissociabilidade teórico-prática no currículo.

ABSTRACT Objective To understand how the theoretical-practical articulation is effective in a curriculum of an undergraduate Nursing course. Method This is a unique case study, with a qualitative approach, developed through document analysis and individual interviews with semi-structured script with 10 teachers and 14 students interviewed from February to May 2015. Data analysis was performed according to the assumptions of Critical Discourse Analysis. Results The data revealed the existence of tensions and ambivalences among two forms of relationship between theory and practice. The first, related to theory-practice as an indissoluble unit and the second, to the view of theory and practice as dichotomous instances and the predominance of theory preceding practice. Conclusions and implications for practice There are weaknesses in the implementation of theoretical and practical articulation in the curriculum of the Nursing course investigated, showing the supremacy of the cartesian paradigm in higher education in Nursing. Thus, it is urgent to institute strategies that enable the theoretical-practical inseparability in the curriculum.

RESUMEN Objetivo Comprender cómo la articulación teórico-práctica es efectiva en un plan de estudios de un curso de pregrado en Enfermería. Método Este es un estudio de caso único, con enfoque cualitativo, desarrollado a través del análisis de documentos y entrevistas individuales con guiones semiestructurados con diez maestros y 14 estudiantes entrevistados de febrero a mayo de 2015. El análisis de datos fue realizado de acuerdo con los supuestos del análisis crítico del discurso. Resultados Los datos revelaron la existencia de tensiones y ambivalencias entre dos formas de relación entre teoría y práctica. El primero, relacionado con la teoría-práctica como una unidad indisoluble y el segundo con la visión de la teoría y la práctica como instancias dicotómicas y el predominio de la teoría que precede a la práctica. Conclusiones e implicaciones para la práctica Existen debilidades en la implementación de la articulación teórica y práctica en el currículo del curso de Enfermería investigado, lo que demuestra la supremacía del paradigma cartesiano en la educación superior en Enfermería. Por lo tanto, es urgente establecer estrategias que permitan la inseparabilidad teórica y práctica en el currículo.